Replacing Missing Laterals:
presented by
Ron Jackson, DDS, FACD, FAGD, FAACD
to benefit
In conjunction with
January 25, 2018
2/4/2018
1
Friday Factoids – July 28, 2017www.fauquiernow.com
• Fiscal Year ending June 30, 2017 – 3,164 dental patient visits
• Represents 24% increase from previous year (2,550 visits)
• 1,269 patients seen from Fauquier & Rappahannock counties a 10.7% increase from previous year
• Clinic spent - $285,300 on dental care up 8% from 2016
• Autosomal dominant trait
• Occurs in over 4% of the population
• Females to males 2:1
• 2/3 have both missing upper laterals
• 1/2 of those with only one missing –contralateral tooth is deficient or peg
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
• Canine Substitution
1) Size
2) Shape
3) Color
4) Gingival crest height
5) Function
2011
2/4/2018
2
2013
20132011
Line Angle
Reduce & round lingual cusp
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
2/4/2018
3
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
- XXXX, General DentistGen Dent, September/October 2008; 56 (6):516-519
Replacement of Congenitally Missing Incisors with Implant Crowns
“Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients.”
- XXXX, PeriodontistDental Products Report February 2008; 34-36
Implants at any Age
“… it’s still unclear at what age implants can be placed -….This article presents clinical evidence that implants can be successfully placed in patients younger than 18.”
Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7
“maxillary lateral incisor implants are challenging esthetically.the amount of space is often small,the papillae are occasionally short,the adjacent roots could be too close,
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Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7
“maxillary lateral incisor implants are challenging esthetically.the amount of space is often small,the papillae are occasionally short,the adjacent roots could be too close, the gingival levels may be uneven, and the patient could be too young.”
1) Lekholm U. The Use of Osseointegrated implants in growing jaws.Int. J Oral Maxillofac Implants 1993;8:243-244.
2) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients – case report. Int. J Periodont Restor Dent 1996;16:421-433.
3) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up StudyEuropean Journal of Orthodontics 23 (2001), #6 pp 715-731
4) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement.Int J Oral Maxillofac Implants 2006; 21: 867-878
Articles about the use of implants in adolescents:
1) Lekholm U. The Use of Osseointegrated implants in growing jaws.Int. J Oral Maxillofac Implants 1993;8:243-244.
2) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients – case report. Int. J Periodont Restor Dent 1996;16:421-433.
3) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up StudyEuropean Journal of Orthodontics 23 (2001), #6 pp 715-731
4) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement.Int J Oral Maxillofac Implants 2006; 21: 867-878
Articles about the use of implants in adolescents:
Facial Development, Continuous Tooth Eruptionand Mesial Drift as Compromising Factors for
Implant Placement
“….. jaw growth may compromise theoutcome of oral rehabilitation using implant-supported prostheses even if the implants aresuccessfully integrated.”
“It should be noted that the age at which growth is complete varies widely.”
- Heij DG, Opdebeeck H, et.alIn J Oral Maxillofac Implants 2006; 21: 867-878
Orthodontic Aspects of the Use of Oral ImplantsIn Adolescents: A 10-year Follow up Study;Thilander B, Odmon J, Lekholm U, European Journal of Orthodontics 23(2001), #6pp 715-731
Implant in lateral position 15 year old male
Age 18 1.6mm infraocclusion
Age 252.2mm infraocclusion
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“ The best method of evaluating the completion of facial growth is by superimposing sequential cephalometricradiographs taken at least one yearapart…..
Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7
The AVERAGE age at which facial growth stops in girls is about 17 years
and in boys it is about 21 years of age.”
?????????
Face Height and Tooth Eruption in Adults –a 20-year Follow-up Investigation
- Forsberg CM, Eliasson S, Westergren HEuro J Ortho 1991 13(4): 249-254
• 15 men and 15 women ages 25-45 yrs.
• Significant changes in anterior facial height
• Dentoalveolar change indicative of continued eruption and vertical growth of the surrounding tissues.
1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11):1024 – 1028.
2) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant.Int J Oral maxillofac Implants 2000; 15: 252-260.
3) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report.J Prosthet Dent 2004; 92: 213-215.
4) Zachrisson BU. Single implant supported crowns in the anterior maxilla – potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: 306-312.
5) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants.Int J Oral Maxillofac Impl 2012; 28:163-169
6) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation.Gen Dent July/Aug 2017; 7-11
Articles about the use of implants in adults:
3-dimensional craniofacial skeletal growth and remodeling are continuous throughout life
1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11):1024 – 1028.
2) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant.Int J Oral maxillofac Implants 2000; 15: 252-260.
3) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report.J Prosthet Dent 2004; 92: 213-215.
4) Zachrisson BU. Single implant supported crowns in the anterior maxilla – potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: 306-312.
5) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants.Int J Oral Maxillofac Impl 2012; 28:163-169
6) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation.Gen Dent July/Aug 2017; 7-11
Articles about the use of implants in adults:
3-dimensional craniofacial skeletal growth and remodeling are continuous throughout life
Long-term vertical changes of the anterior maxillary teethadjacent to single implants in young and mature adults:
A Retrospective Study-Bernard JP, Schatz JP, Christou P, et.alJ Clin Periodontol 2004; 31: 1024-1028
14 Young Adults (Ages 15 – 21)
.1 – 1.65mm implant infraocclusionover 1-9 years
14 Mature Adults (Ages 40 – 55)
.1 – 1.86mm implant infraocclusionover 1-9 years
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Conclusions:
1) Some vertical changes small over 9 yearsSome vertical changes significant over 1year
Highly variable2) Mature adults can exhibit major vertical steps
after anterior restorations with osseointegrated fixtures to the same extent as adolescents or “young adult” individuals with residual growth potential.
Adult Growth, Aging and the Single-Tooth Implant
- Oesterle LJ, Cronin RJInt J Oral Maxillofac Implants 2000; 15: 252-260
“While the average changes are small, apatient demonstrating maximum growth mayshow 2 to 3mm of vertical increase in the natural teeth …..”
Implant Crown #9 Female - Age 24
Age 29
2mm
Implant Crown #9 Female - Age 24
Age 29
2mm
Cases Courtesy of:Dr. Sverker Toreskog
Implant Crown #815 year post op
(placed Age 20)
Inside Dentistry, Oct. 2008, pp. 82 – 87
Courtesy Drs. Coachman, Garber, Salama
Age 33Implant Crown
10 years post op
Age 23Implant Crown #9
Try-in New implant Crown
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Zirconia Abutment with Pink Composite
Immediate Post-op new crown
Cleaning new implant crown
Age 28
Age 382mm short
Tarlow Jeffrey, J Prosthet Dent, September 2004;92:213 – 215.
At insertion .5mm short
1.5mm change
Female Age 22 internal resorption #8
General DentistryJuly 2013
- Zachrisson BUWorld J Ortho 2006; 7: 306 - 312
Implant-supported Crowns in the Esthetic Zone:Long-term effects
1. Darkening (“blue-coloring) of the overlying labial gingiva
2. Progressive infraocclusion of the crown (even in mature Adults)
3. Gingival retraction and “root” exposure
Single Implant-supported Crowns in the anterior maxilla – potential esthetic long-term
(>5 years) problems- Zachrisson BUWorld J Ortho 2006; 7: 306 - 312
“…the fact that the space for a missing incisorcan now be substituted with an implant-supported crown does not necessarily imply that this replacement fulfills optimal esthetic requirements, and that this technique is superior to other treatmentoptions in a lifelong perspective for the patient.”
- XXXX, General DentistGen Dent, September/October 2008; 56 (6):516-519
Replacement of Congenitally Missing Incisors with Implant Crowns
“Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients.”
- XXXX, PeriodontistDental Products Report February 2008; 34-36
Implants at any Age
“… it’s still unclear at what age implants can be placed -…. This article presents clinical evidence that implants can be successfully placed in patients younger than 18.”
2/4/2018
8
• Canine Substitution
• Removable Partial Denture (Flipper)
• Conventional 3 Unit Bridge
• Maryland Bridge
• Implant
• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)
“ If patients are immature at the end of orthodontics and will have significant facial growth,
Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7
it may be appropriate to place a bonded rather than a removable retainer in order to prevent reapproximation of the central incisor and canine roots.”
15 year old
19 year old
19 year old Female
19 year old Female
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9
19 year old Female
D1 D2D1
.75~D2
19 year old Female
D1 D2D1
.75~D2
Shallow Overbite
NormalOverbite
DeepOverbite
Shallow Overbite
NormalOverbite
DeepOverbite
Shallow Overbite
NormalOverbite
DeepOverbite
Excess Horizontal Overjet .5 - .7mm
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Shallow Overbite
NormalOverbite
DeepOverbite
Excess Horizontal Overjet .5 - .7mm
- Shallow Overbite- .5mm excess Horizontal Overjet
- Shallow Overbite- .5mm excess Horizontal Overjet.5mm
depth
.75mm Inlay prep
.75mmdepth
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7.39 / 9.04 = 82% 6.58 / 9.04 = 72%
7.39 / 9.04 = 82% 6.58 / 9.04 = 72%
Reduce space by¾ mm
A1
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A1
1. 2-step Self-etch 1-step Self -etch
2. Remove air inhibited layer with alcohol pledget
OR
Universal
Apply scrubbing20 seconds & dry
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Apply scrubbing15 seconds & dry
Apply scrubbing15 seconds & dry
Apply scrubbing20 seconds & dryApply scrubbing15 seconds & dry
Remove Air Inhibited layerWith Alcohol Pledget
Try-in
Mock up
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Mock up
Ivoclar Bisco
OR
Optidisc (Kerr)
Optidisc (Kerr)
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Optidisc (Kerr)
Optidisc (Kerr)
Optidisc (Kerr)
3 month post op
17 Year old Male
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17 Year old Male
17 Year old Male
- 2.5mm - 1.5mm
Add to gingival surfaces of denture teeth
to maintain pontic sites
Add to gingival surfaces of denture teeth
to maintain pontic sites
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Add to gingival surfaces of denture teeth
to maintain pontic sites
A1
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Ultradent (800-552-5512)
Star Brush
2% Chlorhexidine
Ultradent
888-822-4890 www.cognident.com
Adhesive applied, dried, cured
Other Choices:RelyX Veneer (3M/Espe)
Choice 2 (Bisco)
Nexus 2 (Kerr)
Flowable Resin
Other Choices:RelyX Veneer (3M/Espe)
Choice 2 (Bisco)
Nexus 2 (Kerr)
Flowable Resin
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Other Choices:RelyX Veneer (3M/Espe)
Choice 2 (Bisco)
Nexus 2 (Kerr)
Flowable Resin
6 month Post Op
20 year old female
20 year old female
2/4/2018
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Suck-down matrixon preop model
Suck-down matrixon preop model
Suck-down matrixon preop model
Suck-down matrixon preop model
Suck-down matrixon preop model
Uncured Compositein matrix
Seat Matrix and Cure
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Fill preps with Flowable and cure
17 Year old Male
5 years post op
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17 Year OldDirect Resin Veneer
at 4 years
5 years post op
17 year old female
D2D1
.95~D2 D1
17 year old female
D2D1
.95~
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17 year old female
D2D1
.95~
17 year old female
D2D1
.95~
• Not Desired by the Patient
• Restoratively Contraindicated
40 year old
12 years post op
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Fractures
Ceramic Veneer Retained Bridge
Bonded Porcelain Restorations in the Anterior Dentition:A Biomimetic Approach; Magne P, Belser U. Quintessence 2002
1 year post op
20 year post op: Implant #7 placed at age 19
1mm3mm
20 year post op: Implant #7 placed at age 19
1mm3mm
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20 years
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LongevitySuccess Rate varies widely :
54% failure rate over 11 months
to
90% success rate over 11 years
Technique Dependent
Long-term Clinical Performance of Resin-bonded Fixed Partial Dentures with Retentive
Preparation Geometry in Anterior and Posterior Areas
-Aggstaller H, Beuer F, et.al.J Adhes Dent 2008; 10: 301-306
Retentive preparation design –88% survival at 10 years
Average Survival - 16 years
Longevity of fiber-reinforced composite fixed partial dentures (FRCFPD) – Systematic review
- Ahmed KE, Li KY, Murray CAJ Dent 2017; 61: 1-11
Survival – 94.5% at 4.8 years
Retentive tooth preparations performedbetter than retainers without a preparation
Conclusion:
FRC FPDs demonstrated high overall survival with predictable performance outcomes
FRC FPDs should no longer be considered as experimental, temporary or short term treatment modalities.
Quint Whipple, CDTAcknowledgment:
www.phoeniciandental.com888-888-6215
Alternative Bridge Designusing
Glass Ceramic (emax)
Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed Dental Prostheses.
Kern M. J Dent 2017; 56: 133-135
Barwacz, CAJERD 2014 Vol 26 No. 5 pp.314-323
emax (Ivoclar Vivadent)
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Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors
- Kern M, Passia N, et. AlJ Dent 2017; 65: 51 - 55
Anterior zirconia ceramic cantilever RBFDPs provided excellent clinical longevity
Conclusion:
RESOURCES
The International Association of Physiologic Aesthetics (IAPA) 866-669-4222 or
www.theiapa.com
American Academy of Cosmetic Dentistry Annual Meeting (AACD) 800-543-9220 or
www.aacd.com
Photography Equipment:
• Washington Scientific Camera – 615 Wood Avenue Sumner, Washington 98390
253-863-2854 or [email protected]
• Norman Camera - 3602 S. Westnedge Kalamazoo, Michigan 49008
800-900-6676 or www.normancamera.com
Photography/Software Courses:
• Dr. Greg Lutke – Dallas Dental Solutions Plano, Texas 866-801-9733 or
www.dental-solutions.com
Photo Mounts (to send photos to patients):
(UP#488 – “Your New Smile”) Ultradent Products, Inc. 800-552-5512 or www.ultradent.com
Reality and “Reality Now”
Esthetic Dentistry Research Group
www.realityesthetics.com
(800) 544 – 4999
Journal of Adhesive Dentistry
Quintessence Publishing Co., Inc.
www.quintpub.com
(630) 682 – 3223
SELECTED BIBLIOGRAPHY
1. Lekholm U. The Use of Osseointegrated implants in growing jaws.
Int. J Oral Maxillofac Implants 1993;8:243-244.
2. Westwood RM, Duncan JM. Implants in Adolescents: a literature review and case reports. Int.
J Oral Maxillofac Implants 1996;11:750-755.
3. Johansson G, Palmqvist S, Svenson B. Effects of early placement of a single tooth implant, A
case report. Clin Oral Implants Res 1994;5:48-51.
4. Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following
placement of single-tooth implants in young patients – case report. Int. J Periodont Restor
Dent 1996;16:421-433.
5. Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents:
A 10-year Follow up Study European Journal of Orthodontics 23 (2001), #6 pp 715-731
6. Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial
Drift as Compromising Factors for Implant Placement.
Int J Oral Maxillofac Implants 2006; 21: 867-878
7. Forsberg CM, Eliasson S, Westergren H. Face Height and Tooth Eruption in Adults – a 20-
year Follow-up Investigation Euro J Ortho 1991 13(4): 249-254\
8. Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S Long-term vertical changes of the
anterior maxillary teeth adjacent to single implants in young and mature adults: A
retrospective study, , J Clin Periodontol 2004 Nov; 31(11): 1024-8
9. Oesterle L, Cronin Jr. RJ, Adult growth, aging and the Single-tooth Implant, In
J Oral Maxillofac Implants 2000; 15: 252-260
10. Thilander B, Odman J, Lekholm U, Orthodontic aspects of the use of oral implants in
adolescents: a 10-year follow-up study, European J Ortho 23 (2001): 715-731
11. Tarlow J, The effect of adult growth on an anterior maxillary single-tooth implant: A clinical
report, J Prosthet Dent 2004; 92:213-5
12. Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated
Implants. Int J Oral Maxillofac Impl 2012; 28:163-169
13. Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch
Maturation. Gen Dent July/Aug 2017; 7-11
14. Zachrisson BU Implant-supported Crowns in the Esthetic Zone:
Long-term effects, World J Ortho 2006; 7: 306 – 312
15. Zachrisson BU Single Implant-supported Crowns in the anterior maxilla – potential esthetic
long-term (>5 years) problems, World J Ortho 2006; 7: 306 – 312
16. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition:
A Biomimetic Approach; Quintessence 2002
17. Aggstaller H, Beuer F, et.al. Long-term Clinical Performance of Resin-bonded Fixed Partial
Dentures with Retentive Preparation Geometry in Anterior and Posterior Areas, J Adhes
Dent 2008; 10: 301-306
18. Ahmed KE, Li KY, Murray CA Longevity of fiber-reinforced composite fixed partial dentures
(FRCFPD) – Systematic review, J Dent 2017; 61: 1-11
19. Kern M., Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed
Dental Prostheses. J Dent 2017; 56: 133-135
20. Kern M., Passia N, et.al. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed
dental prostheses and the influence of the reasons for missing incisors, J Dent 2017; 65: 51 -
55
21. Papacchini F, Dall’Oca S, Chieffi N, et.al, Composite-to-Composite Microtensile Bond
Strength in the Repair of a Microfilled Hybrid Resin: Effect of Surfact Treatment and
Oxygen Inhibition, J Adhes Dent 2007; 9: 25-31
22. Dudney T, Advantages and Disadvantages of Treatment Options for Congentially Missing
Lateral Incisors, Inside Dentistry Sept. 2008 pp. 68-70